Provider Demographics
NPI:1497078752
Name:RAFIQUE, ASIM (MD)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:
Last Name:RAFIQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8732
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:2020 SANTA MONICA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2124
Practice Address - Country:US
Practice Address - Phone:310-582-6220
Practice Address - Fax:310-582-6222
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118312207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine